General Assembly
Economic and Social Council

Distr. GENERAL

16 May 1995

ORIGINAL:
ENGLISH

GENERAL ASSEMBLY ECONOMIC AND SOCIAL COUNCIL
Fiftieth session Substantive session of 1995
Item 12 of the preliminary list* Item 6 (l) of the provisional
REPORT OF THE ECONOMIC AND SOCIAL agenda**
COUNCIL ECONOMIC AND ENVIRONMENTAL
QUESTIONS: REPORTS OF
SUBSIDIARY BODIES, CONFERENCES
AND RELATED QUESTIONS:
PREVENTION AND CONTROL OF
ACQUIRED IMMUNODEFICIENCY
SYNDROME (AIDS)
Progress in the implementation of the global AIDS strategy
Note by the Secretary-General
The Secretary-General has the honour to transmit to the General Assembly
and to the Economic and Social Council, pursuant to Assembly resolution 47/40
of 1 December 1992 and Council resolution 1993/51, the report of the
Director-General of the World Health Organization (WHO) on the progress made
in the implementation of the global AIDS strategy.
________________________
* A/50/50.
** E/1995/100.
95-14693 (E) 020695 /...
*9514693*
CONTENTS
Paragraphs Page
I. GLOBAL AIDS SITUATION .................................. 1 - 43
II. ACTIVITIES CARRIED OUT IN 1993-1994 BY THE WHO GLOBAL
PROGRAMME ON AIDS ...................................... 5 - 553
A. Technical cooperation .............................. 5 - 233
B. Research and intervention development .............. 24 - 358
C. Women and AIDS ..................................... 3610
D. Sexually transmitted diseases ...................... 37 - 3911
E. Avoidance of discrimination/promotion of human
rights ............................................. 40 - 4111
F. Collaboration with non-governmental organizations .. 42 - 4312
G. Advocacy ........................................... 44 - 4712
H. Activities carried out in 1993-1994 in collaboration
with other organizations and specialized agencies of
the United Nations system .......................... 48 - 5513
III. ACTIVITIES CARRIED OUT IN 1993-1994 BY ORGANIZATIONS AND
SPECIALIZED AGENCIES OF THE UNITED NATIONS SYSTEM ...... 56 - 11815
A. Centre for Human Rights of the United Nations
Secretariat ........................................ 56 - 5915
B. United Nations Children's Fund ..................... 60 - 7216
C. United Nations Development Programme ............... 73 - 8019
D. United Nations Population Fund ..................... 81 - 9221
E. Office of the United Nations High Commissioner for
Refugees ........................................... 93 - 9623
F. United Nations International Drug Control Programme 97 - 9824
G. International Labour Organization .................. 99 - 10525
H. Food and Agriculture Organization of the United
Nations ............................................ 106 - 10926
I. United Nations Educational, Scientific and Cultural
Organization ....................................... 110 - 11227
J. International Civil Aviation Organization .......... 113 - 11428
K. World Bank ......................................... 115 - 11829
I. GLOBAL AIDS SITUATION
1. The cumulative number of AIDS cases reported to the WHO Global Programme
on AIDS through the WHO regional offices and WHO collaborating centres on
AIDS, as of 31 December 1994 was 1,025,073 from 192 countries. However, the
actual total at the end of 1994 was estimated to be over 4.5 million.
Reasons for the discrepancy include less-than-complete diagnosis and
reporting to public health authorities, as well as delays in reporting.
2. WHO estimates that 19.5 million men, women and children had been infected
with the human immunodeficiency virus (HIV) worldwide by the end of 1994.
Two thirds or more of all HIV infections to date have been the result of
heterosexual transmission, and this proportion will increase to 75 per cent
or 80 per cent by the year 2000. By the end of 1994, about half of all HIV
infections in the world had been acquired in adolescence and young adulthood.
3. Approximately one out of three children born to an HIV-infected woman is
HIV-infected and dies of AIDS, usually by the age of five years; the
remainder eventually become orphans when their mothers or both parents die of
AIDS. By the end of 1994, about 1.5 million infected children had been born
to HIV-infected women, and over half of them had developed AIDS. Most of
these children are in sub-Saharan Africa.
4. Conservatively, WHO projects that by the year 2000 a world total of at
least 30 to 40 million men, women and children will have been infected with
HIV since the start of the pandemic. Even as a conservative estimate, this
represents double the present total. If these estimates are accurate, by the
end of the 1990s, nearly 10 million AIDS-related deaths may be expected.
II. ACTIVITIES CARRIED OUT IN 1993-1994
BY THE WHO GLOBAL PROGRAMME ON AIDS
A. Technical cooperation
1. Coordination and monitoring of national programme support
5. During 1993-1994, technical cooperation provided to national AIDS
programmes was closely monitored to ensure that it responded to priority
needs identified by countries, whose activities continued to involve an
increasing number of participating sectors, funders and implementers. The
Programme's computerized database containing "country profiles" initiated in
1993 was further developed to meet the needs of users - national programmes,
donors and staff at headquarters and in regional offices - and now includes
information from WHO and other sources on demographic, socio-economic and
epidemiological trends, sexually transmitted diseases (STDs), condom
programming and blood transfusion services, among others. The following are
some examples of activities in the different WHO regions.
Africa
6. Despite the distribution of information and educational materials for
AIDS prevention and care, behaviour change remains a challenge for national
AIDS programmes in the region. Nevertheless, there has been a dramatic rise
in the number of condoms sold or distributed over the past five years. Some
countries made special efforts during the year to assess the safety of blood
transfusion in health-care settings with a view to developing a national
policy. Sentinel surveillance activities are being implemented as planned in
many countries, but in some they are hampered by a lack of resources to
purchase HIV test kits or maintain equipment. Community mobilization
continued to receive attention at the national and district levels with the
active participation of the United Nations Children's Fund (UNICEF), the
United Nations Development Programme (UNDP), the World Health Organization
(WHO), many non-governmental organizations (NGOs) and other partners. World
AIDS Day activities and consensus workshops for the preparation of updated
medium-term plans were often presided over by heads of State or ministers of
health. The number of women's organizations and associations becoming
involved in AIDS work is growing rapidly, and more external resources are
required for their support. Several models of community-based home care now
exist that aim to provide a continuum of care for AIDS patients and their
families.
The Americas
7. During 1993, second-cycle medium-term plans were completed for Chile,
Ecuador and Uruguay, initiated in Bolivia, Colombia, Paraguay, Peru and
Venezuela and revised in five Caribbean countries. During 1994, protocols
for HIV sentinel surveillance were prepared and implemented for the first
time in Argentina, Bolivia, Chile, Paraguay, Peru and Uruguay. An external
review was carried out in Mexico; and Cuba prepared a draft of its first
medium-term plan. Training activities included two programme management
courses (Antigua and Barbuda in June 1994 in English; and Uruguay in November
1994 in Spanish); a workshop on applied epidemiology and strategic planning
for Central American and Andean countries in March 1993 in Honduras;
workshops for blood safety and quality assurance (Brazil, Chile and Uruguay,
1993); a workshop on surveillance (Chile, October 1994); a condom promotion
and logistics workshop (Costa Rica, November 1994); and a course on
home-based care for HIV-infected children (Bahamas, June 1994). Protocols to
determine the effectiveness of syndromic STD clinical management were
developed in Brazil and Peru; and Honduras and Suriname will submit similar
protocols shortly.
South-East Asia
8. In 1993, support was given to Bhutan, Indonesia, Mongolia, Myanmar and
Sri Lanka to carry out external programme reviews and initiate the process of
formulating their second medium-term plans. The Programme continued to
emphasize HIV prevention and care and the improvement of AIDS programme
planning and management, providing technical support in various fields to all
countries of the region. Guidelines for national programme managers on HIV
sentinel surveillance were prepared and a training manual on counselling was
finalized and distributed to all countries of the region following
field-testing in India and Nepal. Intercountry training activities were
conducted on programme management (Thailand, April 1994); HIV prevention
indicators (India, July 1994); and condom marketing (Nepal, November 1994).
A consultation was organized to develop an information, education and
communication strategy for AIDS prevention (India, March 1994).
Europe
9. In order to support the countries of Central and Eastern Europe in the
mobilization of national and international resources, a meeting of ministers
of health and of finance on investment in health was held in Latvia in April
1993. The major outcomes were the Riga statement and the introduction of the
Riga initiative. In 1994 country workplans for HIV/AIDS activities were
agreed with 26 member States in Central and Eastern Europe. Assessment
visits were carried out in Armenia, Belarus, the Czech Republic, Kazakstan,
Kyrgyzstan, the Republic of Moldova, Turkmenistan and Uzbekistan. The trend
is towards giving more emphasis to health promotion and ensuring the
participation of NGOs in programme implementation. A Russian version of the
WHO Global Programme on AIDS management course was produced and used to train
staff from Belarus, the Republic of Moldova, the Russian Federation and
Ukraine.
Eastern Mediterranean
10. During 1993-1994, health promotion activities continued to receive the
highest priority, particularly for the prevention of sexual transmission of
HIV. Technical support was provided to national AIDS programmes in the areas
of health education, clinical management of HIV/AIDS, planning and evaluation
and STD control. Iraq, Lebanon and the Libyan Arab Jamahiriya drew up their
first medium-term plans, and second medium-term plans were prepared by
Cyprus, Djibouti, Egypt, Jordan, Morocco, Pakistan, the Sudan, the Syrian
Arab Republic and Tunisia. External reviews were carried out in Cyprus, the
Islamic Republic of Iran, Jordan, Morocco, Pakistan and the Syrian Arab
Republic. Intercountry and regional training activities were conducted on
the following subjects: epidemiological surveillance (Egypt, April 1993);
programme management (Cyprus, April 1994); management of HIV/AIDS and care of
persons with HIV (Tunisia, September 1994); and the role of media in AIDS
prevention (Egypt and Pakistan, November 1994). Other activities included a
regional meeting on the role of women in AIDS prevention and control (Egypt,
May 1994) and a meeting of directors of national AIDS reference laboratories
(Egypt, November 1994).
Western Pacific
11. During 1993-1994, the national AIDS plans of China, Cook Islands, Fiji,
Kiribati, the Lao People's Democratic Republic, Marshall Islands, Papua New
Guinea, the Philippines, Samoa, Tonga, Vanuatu, Viet Nam and the territories
of French Polynesia and New Caledonia were reviewed, and China formulated its
second medium-term plan. Three workshops were held on the improvement of
counselling skills (Cambodia, February 1993; Viet Nam, August 1993; and Guam,
October 1993). A regional workshop on condom logistics (Manila, February
1994) emphasized the importance of condom quality and the continuity of
supply. Two meetings of national AIDS programme managers were held during
the year (Guam, March 1994; Manila, August-September 1994). Viet Nam and
Papua New Guinea introduced HIV/AIDS into the curriculum of secondary schools
as part of health education or science subjects. In the Philippines the
secondary school curriculum was revised to include HIV/AIDS. STD prevalence
studies were conducted in Fiji and the Philippines. Technical support was
provided to Cambodia on STD case management.
2. Planning, management and training
12. One of the major achievements during 1993 was the field-testing and
finalization of the programme management training course, which provides a
comprehensive approach for the development of national AIDS programmes.
During 1994, 30 facilitators for the course were trained in 4 courses; they
in turn helped to train participants from 80 countries in 7 intercountry
courses and 2 national courses (Botswana, Kenya). Translations of the 12-
module course were completed in Chinese, French, Russian and Spanish.
Arrangements were made for field-testing of the first training modules for
strengthening district-level management of AIDS prevention, care and support
activities in one country of Africa during the fourth quarter of the year.
The first course for training trainers on safe blood and blood products,
using distance-learning materials, was held in Zimbabwe in October.
13. The procedures for national AIDS programme reviews and medium-term
planning were updated to reflect the changed environment facing national
programmes. External programme reviews were carried out in 55 countries
during the biennium 1993-1994. Of the 129 countries and Territories that had
prepared an initial medium-term plan, 70 have used a consensus-building
approach to formulate a multisectoral strategic plan.
14. Support was provided to strengthen the managerial and technical skills of
national networks of NGOs in India, Kenya, Malaysia, the Philippines and
Zimbabwe. A list of essential AIDS information resources was prepared and
distributed in English, French and Spanish in collaboration with the
Appropriate Health Resources and Technologies Action Group (AHRTAG), United
Kingdom. A workshop for training trainers in NGO management and project
development was conducted in Bratislava in November 1994.
3. Prevention
15. A meeting to examine broader, policy-oriented approaches that attempt to
alter the social or physical environment or circumstances in which
risk-taking occurs was convened in September 1993. Case studies from 12
countries with diverse risk situations were analysed and a research agenda
drawn up to evaluate such approaches further.
16. A guide on designing and conducting interventions for young people not
attending school will be completed by mid-1995. A supplement on youth peer
education was published in August 1994 in the AHRTAG newsletter AIDS action,
and plans for the expansion of peer education interventions in Ghana and
Jamaica are under way. A workshop to promote greater involvement of the
private sector was held in Uganda (December 1994). In collaboration with an
international insurance company, a series of national workshops were
organized in Hong Kong, Indonesia and Malaysia to encourage the private
sector to play a more active role in AIDS prevention and care. In April the
technical content and format of the WHO specifications and guidelines for
condom procurement were revised. A set of condom programming materials for
national managers, including manuals on rapid assessment, promotion and
logistics, was finalized and will be available in 1995. A study was
conducted to project future condom needs, as part of an overall contraceptive
needs study. Global requirements for STD and HIV/AIDS prevention through the
year 2005 were estimated to be as high as 20,000 million condoms, costing
some US$ 1,200 million.
4. Health care and support
17. Guidelines for the clinical management of HIV infection in adults 1/ were
field-tested in national consensus workshops in Barbados, Burundi and
Thailand. Based on the result of the field-test, a guide for facilitators of
these workshops was prepared, which outlines the methodology for adapting
these guidelines to country needs. A similar document, entitled "Guidelines
for the clinical management of HIV infection in children" has been
finalized. 2/ The AIDS home care handbook was finalized 3/ and the booklet
Living with AIDS in the community was revised. 4/ Both are intended to
assist district health-care workers in providing HIV/AIDS care, in teaching
persons with AIDS and their family members to cope at home, and in
encouraging communities to help those infected with and affected by HIV to
adopt a positive approach to life.
18. An expert consultation on care held in September re-emphasized the
rationale for giving access to comprehensive care, including clinical,
nursing, counselling and social support in a continuum from home to hospital,
and stressed the close link between such care and prevention. The report of
an evaluation of medical, counselling and social services rendered by The
AIDS Support Organisation (TASO), Uganda, will help NGOs and Governments to
learn from a success story and a participatory approach to evaluation.
19. A handbook on integrating comprehensive AIDS care into district health
services was prepared for Ghana and district planning of care is under way in
Thailand and Uganda. The development of clinical guidelines was completed
with the printing of a French version of the WHO Global Programme on AIDS
paediatric guidelines. Additional material to facilitate adaptation of the
clinical guidelines to country needs was produced, including a short guide on
adapting flow-charts; a clinical slide set for teaching purposes; and a paper
on selecting commonly used drugs in HIV/AIDS care. Guidelines for policy
makers, programme managers and service providers on appropriate infant
feeding modes in the light of the HIV epidemic were finalized and will be
available in 1995.
20. Technical support was provided to India on the training of trainers in
care and counselling for all States, including an evaluation of methodology
at state and district level. Operational studies are in progress in Kenya on
the feasibility of integrating HIV/AIDS care into the existing urban
governmental and non-governmental health systems, and in India on the
training of hospital personnel and community volunteers to provide care at
the appropriate level and refer patients when necessary.
5. Surveillance, evaluation and forecasting
21. By the end of 1994, sentinel HIV surveillance had been implemented in 80
developing countries, 17 of which now have extensive systems in place.
Trainers from all WHO regions attended a course on surveillance data
management (United States of America, June) organized with financial support
from the World AIDS Foundation. To assist national AIDS programmes, a
methods package for the evaluation of preventive activities was finalized,
and training workshops in its use will be conducted in all regions. In
addition, protocols were developed for measuring indicators related to
discriminatory practices and care for HIV/AIDS patients in health facilities,
and they will be field-tested in two countries.
22. Collaboration began with the London School of Hygiene and Tropical
Medicine to develop techniques for estimating the cost-effectiveness of six
HIV prevention strategies relating to mass media communication, social
marketing of condoms, blood safety, school health education, STD services and
sex worker projects. Costing guidelines for each strategy have been
prepared. Techniques to estimate effectiveness, now being designed, will be
field-tested next year.
23. HIV/AIDS forecasting research has focused on achieving a better
understanding of the changing patterns of HIV incidence in diverse epidemics.
Through collaborative investigations with national AIDS programmes, HIV/AIDS
case data from Rwanda, Uganda, the United Republic of Tanzania and Zambia
have been analysed. The resulting epidemiological model of HIV incidence
suggests a dramatic shift of new infections to younger populations in these
countries and provides insight into the dynamics of endemicity. A
computer-based programme management information system was field-tested in
Namibia and Uganda.
B. Research and intervention development
1. Clinical research and product development
24. An inter-agency working group on the development of vaginal microbicides,
established in collaboration with the Special Programme of Research,
Development and Research Training in Human Reproduction, established
prototype protocols for safety and efficacy testing of such products. A
safety study of a vaginal microbicide containing a low dose of the spermicide
nonoxynol-9 was successfully completed in several European countries and
Thailand, paving the way for a study in Asia and Africa on its efficacy in
preventing sexual transmission of HIV and other STDs. A comparative trial of
the user-effectiveness of two strategies using male and female condoms to
prevent gonorrhoea, chlamydial infection, vaginal trichomoniasis and genital
ulcer diseases among sex workers began in Thailand.
25. A meeting to discuss prevention of mother-to-infant transmission of HIV
by use of antiretrovirals was convened in June; protocols were prepared for
research on short-term peripartum antiretroviral interventions that are
feasible, affordable and sustainable in developing countries and the studies
will be initiated shortly. An inter-agency working group on the prevention
of mother-to-infant transmission of HIV was established to ensure suitability
and complementarity of worldwide research efforts in this field.
26. Research on the prevention of tuberculosis continued in Thailand and
Zambia, and studies on cost-effective maintenance treatment were started in
Uganda for oropharyngeal candidiasis and in Thailand for Penicillium
marneffei infections. Protocols on cost-effective prophylaxis of multiple
opportunistic infections were developed.
27. A meeting on implications of the newly identified HIV-1 subtype O viruses
for HIV diagnosis was convened in June. An inter-agency working group has
been established to expedite and coordinate global surveillance and
characterization of newly recognized HIV subtypes and to facilitate timely
adaptation of HIV antibody tests. Evaluations of such tests in oral fluid
(saliva) in Burundi and Rwanda were successfully completed. Field
assessments of WHO testing strategies were started in Argentina, Mexico and
Uruguay. Field assessments of alternative simple methodologies for CD4+
lymphocyte determinations were initiated in Brazil, Thailand, the United
Republic of Tanzania and Venezuela.
2. Vaccine development
28. Field sites for future HIV vaccine efficacy trials are being strengthened
in Brazil, Thailand and Uganda. For the purpose of the trials, studies on
eight cohorts of HIV-negative volunteers are being supported (three in Brazil
and Uganda, and two in Thailand) to obtain accurate HIV incidence rates
reflecting the protective effect of current non-vaccine interventions (i.e.
counselling, education, promotion of condoms, STD treatment) and to determine
the feasibility of compiling information on recruitment and follow-up.
Protocols were prepared for repeat phase II trials of two HIV candidate
vaccines that have already been tested in their country of origin. Two such
trials to be conducted in Thailand were endorsed by the WHO Global Programme
on AIDS Steering Committee on Vaccine Development. A meeting in October 1994
examined the scientific and public health rationales for the conduct of
efficacy trials of HIV vaccines, especially in developing countries, and
concluded that they could be undertaken with the presently available
envelope-based candidate vaccines, provided strict scientific and ethical
standards are respected.
29. The WHO network for HIV isolation and characterization completed a pilot
study to characterize HIV-1 isolates from WHO-sponsored vaccine evaluation
sites. A rapid and reliable method for virus genotyping was validated
(heteroduplex mobility assay) and is now being used, in conjunction with V3
peptide serology, in more extensive molecular epidemiology studies at the
sites. HIV-1 subtypes have different geographical distributions, and subtype
C strains were identified for the first time in South America. Complete and
functional molecular clones from different HIV-1 genetic subtypes were
obtained and are being made available to researchers and the pharmaceutical
industry, to stimulate the development of candidate HIV-1 vaccines.
3. Social and behavioural studies and support
30. On the advice of the WHO Global Programme on AIDS Steering Committee on
Social and Behavioural Research, research proposals were supported in the
following areas: contextual factors affecting risk-related sexual behaviour
among young people; household and community responses to HIV and AIDS; and
gender relations in the area of sexual negotiation. Studies were funded in
16 developing countries.
31. A report on sexual behaviour and knowledge about AIDS in the developing
world, detailing findings from studies supported by WHO in 15 countries, was
completed and will shortly be published.
32. A generic research protocol for studies of the determinants of
HIV/AIDS-related discrimination, stigmatization and denial is being
finalized, and assessment visits to identify institutions to carry out the
study have so far been conducted in nine countries.
4. Prevention research
33. Research continued to focus on assessing the effectiveness of various HIV
prevention approaches for populations most vulnerable to HIV infection, in
particular, socially marginalized populations. Situation assessments to help
to design and plan interventions were conducted in Malaysia (focusing on
risk reduction among homosexually active men) and India (focusing on
injecting drug users) and are under way in Papua New Guinea (focusing on new
sex-work settings).
34. Intervention-linked prevention research was undertaken at several sites.
For example, studies are under way in Mexico to determine the effectiveness
of condom promotion in migrant sex worker and client populations; in India to
assess the feasibility and effectiveness of outreach measures among injecting
drug users; and in Uganda, where the additional benefit of STD treatment is
being compared with the effect of educational approaches alone. Research
began in Zambia to assess the feasibility and impact of economic
interventions as a means of minimizing the HIV transmission risk to women
traders who are sexually exploited in the course of their work.
35. Preparations are being made for a collaborative multicentre study on the
effectiveness of voluntary counselling and testing as a prevention strategy.
This study, the first randomized controlled trial to be undertaken on this
subject, will take place in conjunction with AIDSCAP, the AIDS control and
prevention project.
C. Women and AIDS
36. The United Nations Development Programme (UNDP) and WHO, in consultation
with the United Nations Division for the Advancement of Women, prepared a
position paper on women and AIDS, reflecting concerns throughout the United
Nations system; and it was used at regional conferences organized during 1994
by the five regional commissions in preparation for the 1995 Fourth World
Conference on Women in Beijing. Further input to the Beijing conference
included a consultation in February 1995 that brought together politicians
and senior policy makers on gender issues and AIDS and produced
recommendations for transmission to the Commission on the Status of Women,
the body responsible for preparing for the conference. A "resource package"
containing practical tools for making AIDS prevention programmes more
"gender-sensitive" is being prepared for distribution at the Beijing
conference. A paper was written on the epidemiology of biological,
behavioural, sociodemographic and sociocultural gender-related risk factors
for HIV/AIDS.
D. Sexually transmitted diseases
37. In January 1994, WHO assumed responsibility for providing the secretariat
of the Sexually Transmitted Diseases Diagnostic Initiative (SDI) - a group of
agencies, laboratory and public health experts and participating centres
which, through a directed programme of research, seeks to design and make
available rapid diagnostic tests that can be used at first-line health
facilities in developing countries. An information meeting, attended by 32
companies interested in such tests, was held in September; and follow-up
research and development activities were initiated.
38. A database for estimating the global annual incidence of STDs was
assembled for use by national AIDS programmes, donors, academic institutes,
foundations and others. In addition, guidelines were developed on assessing
the extent of STDs and the delivery of prevention and control services, and
on establishing a surveillance system to monitor future trends and
anticipated need for services. Information on policies, features of STD
services (e.g. vertical or horizontal, primary or secondary) and existing
laws related to STD control programmes in individual countries was analysed
and a report is in preparation.
39. Flow-charts for case management of the most common syndromes of sexually
transmitted diseases were designed in 1993 and are being evaluated in Ghana,
India, Jamaica and Sri Lanka. A training module on syndromic case management
was developed and field-tested in November. Operational research studies
were initiated in Thailand and Viet Nam on the feasibility of integrating
HIV/STD services into maternal and child health (MCH)/family planning
programmes. Assistance was also given in the formulation by the Special
Programme of Research, Development and Research Training in Human
Reproduction of a proposal to analyse reproductive health needs and conduct
appropriate research within WHO.
E. Avoidance of discrimination/promotion of human rights
40. WHO's policy of withholding sponsorship of international AIDS conferences
in countries that place short-term travel restrictions on HIV-infected people
and people with AIDS was approved by the Administrative Committee on
Coordination (ACC) in October 1993 for application throughout the United
Nations system. According to this policy, WHO and other organizations of the
United Nations system will not sponsor, co-sponsor or financially support
international conferences or meetings on AIDS in countries that have entry
requirements that discriminate solely on the basis of a person's HIV status.
WHO guidelines on HIV infection and AIDS in prisons, 5/ issued in March 1993,
provide standards - from a public health perspective - which prison
authorities should strive to achieve in their efforts to prevent HIV
transmission and to provide care to those affected by HIV/AIDS. In early 1993
the Programme issued a statement, emanating from a consultation
(November 1992), urging that mandatory testing and other testing without
informed consent should not be used in AIDS control programmes, and
indicating the advantages of voluntary testing and counselling. A document
setting out the public health rationale against mandatory testing aimed at
the general public was prepared and issued in 1994.
41. During 1994, the Programme continued to assess national AIDS programmes
on the basis of medium-term plans and reports of external reviews, to ensure
their adherence to human rights principles and to provide technical advice
where necessary. At the request of three Governments, comments were provided
on draft HIV/AIDS legislation. During the year the WHO Global Programme on
Aids country-specific human rights database was modified to improve the
Programme's follow-up capacity. A meeting of experts working in the fields
of HIV/AIDS, human rights, public health and the movement of populations was
held in October 1994 as part of the development of a WHO policy on long-term
travel restrictions imposed on people living with HIV/AIDS.
F. Collaboration with non-governmental organizations
42. The Programme's promotion and support of NGOs during the period 1989-1992
was assessed in 1993. The assessment demonstrated that considerable support
had been provided to NGOs and confirmed the need for the Programme to
continue and expand such work in the following areas: advocacy for
participation of those organizations in the development of government
policies and programmes; support to international, regional and national
networks of NGOs in order to increase their knowledge and skills relating to
HIV/AIDS; and encouragement of greater coordination among NGOs, and between
them and national AIDS programmes in carrying out activities. Ways in which
the Programme and NGOs could work together more effectively were explored
through a consultative process.
43. During 1994 the Programme continued to consult a variety of NGOs,
community-based organizations and groups representing people living with
HIV/AIDS, in order to determine ways of working with them more effectively
and also to produce guidelines on how to improve their collaboration with
national AIDS programmes. Support was provided to major networks of NGOs
actively concerned with HIV/AIDS, and consultations were held with religious
and other networks not yet active in order to stimulate their involvement.
The role of NGOs as partners in policy and programme development at global
and national levels was supported in a variety of ways. Activities to
support community responses focused on collaboration and partnership-building
between Governments and NGOs and also amongst such organizations, as well as
capacity-building within the non-governmental sector.
G. Advocacy
44. During 1994, the Programme continued to focus the world's attention on
HIV/AIDS in order to combat complacency and denial of the problem. Further
to the Dakar declaration on the AIDS epidemic in Africa adopted by the heads
of State and Government of the Organization of African Unity (OAU) in 1992,
6/ at its thirtieth session in June 1994, the Heads of State and Government
of OAU adopted a declaration on AIDS and the Child in Africa, 7/ based on a
background document prepared by WHO and reviewed by the OAU ministers of
health. Other international and regional meetings where WHO took the
opportunity to advocate a stronger response to the pandemic included the
Kuwait fourth international conference on AIDS (March); a meeting on the role
of women in AIDS prevention and control in the Eastern Mediterranean (Egypt,
May); the Economic Commission for Africa panel on HIV/AIDS in Africa
(Ethiopia, June); and the tenth international AIDS conference (Japan,
August). In addition several missions were fielded at a high level in order
to promote greater political commitment by individual Governments to national
AIDS control efforts.
45. At the Paris AIDS Summit, jointly convened by the Government of France
and WHO on 1 December 1994, a declaration was signed by all heads of
Government or their representatives attending for the 42 invited countries.
In its resolution EB95.R14, the Executive Board welcomed the declaration and
the seven initiatives spelled out therein and requested the Director-General,
within the framework of the joint and co-sponsored United Nations programme
on HIV/AIDS, and in close cooperation with its Executive Director, to
contribute to their implementation.
46. Public information continued to play a significant role in advocacy.
Emphasis was placed on stimulating media coverage of key messages about
HIV/AIDS and providing information to policy makers and the general public.
During 1994, 15 press releases were distributed, video news footage was
prepared for the Tenth International Conference on AIDS and, in cooperation
with UNDP, two short video features were distributed to more than 180
countries and broadcast worldwide by satellite. Media strategies were
developed for several major events, including the international AIDS
conference and the Paris AIDS summit. By the end of 1994 the Programme's
quarterly newsletter, Global AIDSnews, was being distributed in 36,000 copies
per issue - 28,500 in English, 5,750 in French and 2,000 in Arabic. In
addition, the People's Medical Publishing House of Beijing translated each
1993 issue and distributed 2,000 copies to addresses in China.
47. Reflecting the fact that 1994 was the International Year of the Family,
the theme chosen for the seventh World AIDS Day on 1 December was "AIDS and
the family". After consulting non-governmental and United Nations system
organizations, and incorporating contributions from these sources, three
World AIDS Day newsletters were published focusing on the effect of AIDS on
families and the role they can play in AIDS prevention and care, together
with a small colour poster bearing the slogan "Families take care".
Comprehensive resource packs of relevant documents were dispatched to all
national AIDS programmes.
H. Activities carried out in 1993-1994 in collaboration
with other organizations and specialized agencies of
the United Nations system
48. The Inter-Agency Advisory Group on AIDS, for which WHO serves as
secretariat, met twice during the year (Geneva, April; New York, November).
The existing 15 United Nations system programmes and organizations which are
members welcomed a request for membership from the United Nations
International Drug Control Programme. Among the items considered at the
meetings were the preparation of a joint position paper on women and AIDS for
the Fourth World Conference on Women; the development by WHO, in consultation
with the United Nations Medical Service and the Department of Peace-Keeping
Operations of the United Nations Secretariat, of health education materials
related to the prevention of HIV infection among peace-keeping forces; and
the production by the Office of the United Nations High Commissioner for
Refugees (UNHCR) and WHO of a minimum package for HIV/AIDS prevention and
care in emergency situations.
49. In July 1994 the Economic and Social Council endorsed the creation of a
joint and co-sponsored United Nations programme on HIV/AIDS and called on the
six co-sponsors (UNDP, UNICEF, the United Nations Population Fund (UNFPA),
the United Nations Educational, Scientific and Cultural Organization
(UNESCO), WHO and the World Bank) to work together to prepare a detailed
proposal for submission to the Council.
50. In December 1994 the Committee of Cosponsoring Organizations met for the
second time and unanimously recommended Dr. Peter Piot as Executive Director
of the programme for a period of two years starting on 1 January 1995, from
which time he was to oversee the work of the transition team, including the
preparation of the detailed proposal requested by the Council.
51. At the 1994 session of the United Nations Subcommission on Prevention of
Discrimination and Protection of Minorities, WHO provided technical advice on
the drafting of a resolution on HIV/AIDS and non-discrimination, and
organized a briefing on HIV/AIDS and human rights. Briefing sessions were
also organized for the United Nations Committee on the Rights of the Child,
and the United Nations Committee on Economic, Social and Cultural Rights. At
a meeting organized by the International Labour Organization (ILO) in October
1994 on population and development, the Programme provided technical input on
the subjects of family planning, mobility of populations and the socio-
economic impact of AIDS, including human rights issues.
52. A project on the control of maternal and congenital syphilis in Lusaka
Province, Zambia, launched by UNICEF with technical assistance from WHO, was
reviewed and a decision made to extend it to other provinces in 1995. Joint
WHO/UNICEF intervention guidelines for the control of maternal and congenital
syphilis are to be published in 1995. WHO also participated in meetings of
UNICEF's five technical support groups for HIV/AIDS in the following areas:
mass communication and community mobilization; sexual and reproductive health
promotion; family and community care; school-based interventions; and youth
and health development promotion. The aim of each group is to provide
technical advice and some financial support for pilot activities in selected
countries. WHO staff were designated as members of each of the groups.
53. The UNDP/WHO Joint Consultative Group, established for the UNDP regional
project on strengthening multisectoral and community responses to the HIV
epidemic in Asia and the Pacific, met twice during the year (New Delhi,
April; Viet Nam, December) with the participation of WHO headquarters and the
three regional offices concerned. WHO also provided technical input to the
project in respect of legal and economic networking and NGOs. Following an
evaluation of the UNDP regional project on confronting the socio-economic
impact of HIV/AIDS in sub-Saharan Africa, WHO participated with other United
Nations bodies in drafting a new project document including activities such
as training and support to legal networks.
54. WHO provided technical assistance to the World Bank in country assessment
missions for STD programme development and support in four countries. The
two organizations collaborated closely in the formulation of a World
Bank-financed regional HIV/AIDS project for South-East Asia, which will serve
Cambodia, the Lao People's Democratic Republic, Malaysia, Myanmar, the
Philippines, Thailand and Viet Nam, particularly in promoting regional policy
analysis and dialogue and supporting the implementation of priority
strategies and multisectoral initiatives. The World Bank and WHO are also
developing a regional initiative for West African countries, focusing on
intervention projects related to migration.
55. During the year, in collaboration with UNESCO, a resource package on the
design of school AIDS education for use by curriculum planners, teachers and
students (12-16 years) was published, and the final evaluation report of
WHO/UNESCO pilot projects on school AIDS education (1988-1993) was issued.
III. ACTIVITIES CARRIED OUT IN 1993-1994 BY ORGANIZATIONS
AND SPECIALIZED AGENCIES OF THE UNITED NATIONS SYSTEM
A. Centre for Human Rights of the United Nations Secretariat
56. In the field of HIV/AIDS, the efforts of the Centre for Human Rights of
the United Nations Secretariat are essentially focused on the human rights
aspect of the issue. HIV/AIDS-related discrimination is a contravention of
the fundamental principle of non-discrimination, as reaffirmed most recently
in the Vienna Declaration and Programme of Action. 8/ The challenges
presented by HIV/AIDS require renewed efforts to ensure universal respect for
and observance of human rights and fundamental freedoms for all. The Centre
for Human Rights' Legislation and Prevention of Discrimination Branch, at the
level of the Commission on Human Rights and the Subcommission on Prevention
of Discrimination and Protection of Minorities, has been active in the
implementation of the following resolutions in 1993 and 1994.
57. In 1993, the Commission adopted resolution 1993/53, which took note of
the progress reports of the Subcommission's Special Rapporteur on
HIV/AIDS-related discrimination. At its fiftieth session in 1994, the
Commission adopted resolution 1994/49, in which it requested the
Secretary-General to prepare for the consideration of the Commission at its
next session a report on international and domestic measures taken to protect
human rights and prevent discrimination in the context of HIV/AIDS and make
appropriate recommendations thereon. 9/
58. The Special Rapporteur on discrimination against HIV-infected people or
people with AIDS submitted his conclusions and recommendations 10/ in
August 1993 to the Subcommission on Prevention of Discrimination and
Protection of Minorities.
59. In August 1994, the Subcommission adopted resolution 1994/29 requesting
the Commission on Human Rights to approve the organization by the Centre for
Human Rights of a second international expert consultation on human rights
and AIDS, with particular emphasis on the prevention of AIDS-related
discrimination and stigma. In its resolution 1995/44 of March 1995, the
Commission requested the High Commissioner for Human Rights to reflect on the
possibility of organizing such an expert consultation.
B. United Nations Children's Fund
60. In many parts of the world, HIV, the causative agent for AIDS, is
becoming a leading cause of child mortality, morbidity and suffering, a
leading cause of death among young people, as well as a major threat to
social and economic development. Of the 15 million people that WHO estimates
to be infected with the virus, nearly half are young people under the age of
30 and mostly and increasingly women of reproductive age. Children are
affected by the pandemic in many ways: directly, through transmission of the
virus from mother to child, or indirectly through the impact of HIV/AIDS on
the family, the community and the stretching of scarce national resources
allocated to child survival and development. WHO estimates that as of late
1993 about 1 million children had been born with HIV, most of whom will die
before their fifth birthday, and 2.5 million others had lost one or both
parents as a result of AIDS. As many as 5 to 10 million will be orphaned by
the end of this century, with 90 per cent of these children being in Africa.
61. Currently, over 80 per cent of new HIV infections occur in the developing
world. While the problem has been most striking in sub-Saharan Africa, it is
emerging everywhere in the developing world and requires urgent attention.
In contrast, only about 5 per cent of global resources for AIDS prevention
and care are spent in developing countries. During 1993-1994, approximately
60 per cent of these resources were programmed on a multilateral basis,
largely through the WHO Global Programme on AIDS. UNICEF has substantially
increased its involvement in HIV/AIDS prevention and care, mostly through
reallocation of resources within country programmes.
62. The WHO Global Programme on AIDS has provided technical and other
leadership within the United Nations system in response to the HIV/AIDS
pandemic and has worked closely with other United Nations agencies to
incorporate HIV/AIDS prevention and care activities into their programmes of
assistance. While great progress has been made in the first decade of this
epidemic, there remains a greater need for multisectoral and social
mobilization programming. This requires increased emphasis on coordinating
the efforts within the United Nations and among all key actors operating in
developing countries, including bilateral agencies.
63. UNICEF was actively involved and supportive in efforts to consolidate
various coordinating mechanisms. These include the strengthening of the
Inter-Agency Advisory Group on AIDS (IAAG), the main forum for coordination
of HIV/AIDS programme within the United Nations system; the creation of a
task force on HIV/AIDS that addresses coordination between United Nations and
bilateral agencies, NGOs and others engaged in similar efforts; and, the
establishment of a joint and co-sponsored United Nations programme on
HIV/AIDS. The process to establish the joint programme has involved close
consultation amongst the United Nations partners - WHO, UNDP, UNFPA, UNESCO,
The World Bank and UNICEF. Initially this involved an inter-agency working
group, which was followed by a transition team to establish the new Programme
in accordance with the relevant resolutions of the Economic and Social
Council.
64. During 1993 and 1994, UNICEF has worked within the framework of the
global AIDS strategy to develop and implement HIV/AIDS prevention and care
approaches that fit within its programme of assistance, focusing on women and
youth and on the reduction of the impact of HIV/AIDS on children. These
approaches are well described in the following publications: AIDS: the
Second Decade - A Focus on Woman and Youth; Progress report on UNICEF
programme activity in the prevention of the human immunodeficiency virus and
in reducing the impact of acquired immune deficiency syndrome on families and
communities; Young People in Action (report of the Eighth International
Conference on AIDS in Africa, Marrakech, 1993); and Action for Children
Affected by AIDS - Programme Profile and Lessons Learned.
65. UNICEF has recognized the broader societal determinants of the spread of
HIV - particularly the status of women and youth - and seeks to address these
through multisectoral programmes. Principal emphasis has been on sustainable
partnership development in the areas of youth health and development
promotion with youth and community organizations; school-based interventions
with the education system, students, parents and teachers associations;
sexual and reproductive health promotion with the health system, youth, women
and men's groups; mass communication and social mobilization with the
entertainment industry and the mass media; and family and community care with
NGOs, religious institutions and local (community-based) organizations.
66. In an effort to develop and accelerate programming approaches in these
areas that demonstrate "proof of principle" at scale, UNICEF's major emphasis
has been in approximately 30 strategic programming countries, representing
the main geographic regions of the developing world and each focusing
specially in one of the programming areas described above. Support to the
efforts of these lead programming countries is provided through the five
technical support groups in each of the subject areas. The technical support
groups are comprised of UNICEF programme officers from strategic programming
countries, headquarters and regional offices and representatives of
collaborating technical agencies. Key partners in the technical support
groups initiatives include WHO (WHO Global Programme on AIDS, adolescent
health, mental health, STD and women's health, health education divisions),
the Pan American Health Organization (PAHO), UNDP, UNFPA, UNESCO, Family Care
International, Family Health International (AIDSCAP), the International
Children's Center, International Planned Parenthood Federation, ICHAR
(Karolinska Institute), Ogilvy Adams and Rinehart, Rockefeller Foundation,
the Salvation Army, the Centers for Disease Control (CDC) and the World Young
Women's Christian Association (YWCA) among others.
67. In recent months, the growing appreciation of the impact that youth
health and development promotion have on the achievement and sustainability
of the World Summit for Children's year 2000 goals has been increasingly
evident. Although it was HIV/AIDS that more sharply focused UNICEF's
attention on young people, it is clear that a number of other health
behaviours that start during adolescence also need to be addressed, including
other STDs, adolescent pregnancy, substance abuse, violence and poor
nutrition. The strategic programming countries that are concentrating their
efforts in this area (including the Philippines, Uganda, Rwanda, the West
Bank and Gaza) have been able to synthesize and document situation analyses,
policy review and development and programming options. They are also
exploring the priorities for meeting the needs of youth in acute and chronic
emergencies, and designing approaches to involving young people as a resource
in a way that contributes to their health and development.
68. Another key area for youth health and development promotion is
school-based interventions. The objective of these efforts is to provide
young people in schools with both basic health education and the "life
skills" needed to make informed decisions. Health education and curriculum
development, including components on HIV/AIDS prevention, are the programme
areas of concentration for Zimbabwe, Thailand and the Caribbean nations.
Extracurricular activities, including school health clubs and after-school
services are the key elements of innovative initiatives in Cameroon and other
countries.
69. There are now a range of programming examples in UNICEF offices for the
use of mass communication and mobilization strategies to address youth health
issues, including HIV/AIDS: youth involvement in national radio broadcasts
(Cote d'Ivoire); technical assistance to radio talk-back programmes
(Senegal); journalists' training (Egypt); evaluation of the impact of a
television and radio drama that focuses on health issues (South Africa); work
with national television and prominent football teams (Honduras); and the
expansion of Straight Talk, the youth and sexuality newspaper initiated in
Uganda, to other countries. From these and many other experiences, a series
of working instruments for use by UNICEF offices are being developed,
including guidelines and key questions for conducting situation analysis and
programme planning, and a series of programming examples with key universal
principles for action. The range of UNICEF country offices involved in the
technical support group process has expanded from 7 to 10 as have the number
of partners with organizations as diverse as Children Television Workshop,
AIDSCAP and the German Agency for Technical Cooperation all involved in
supporting country and global programming.
70. Sexual and reproductive health promotion is another approach that seeks
to provide quality and user-friendly sexual and reproductive health services
through the primary health care system in a manner that facilitates
partnership-building involving the health sector, women and youth
organizations. The approach utilizes mechanisms already developed through
ongoing programmes and strategies supported by UNICEF and partners such as
the Bamako Initiative (Benin), the health service reform efforts and
decentralization (Zambia, Swaziland) and advocacy programmes (Colombia).
These efforts have contributed to the design of quality and user-friendly
services for STD prevention and care and HIV counselling (Myanmar, Benin) and
for maternal syphilis prevention and control (Zambia). The sustainability of
STD prevention and care services has been addressed through cost-sharing in
the context of the Bamako Initiative strategy (Benin).
71. In the area of family and community care, UNICEF has developed sustained
partnerships over the past years with religious institutions,
non-governmental and community-based organizations in eastern and southern
Africa to address the needs of children and families affected by AIDS. In
1994, WHO and UNICEF joined efforts to document the impact of HIV/AIDS on
children and innovative responses to the needs of these children in their
joint publication Action for children Affected by AIDS - Programme Profiles
and Lessons Learned. The document is meant to raise awareness of the
pandemic's profound consequences for children and share experience among
those with an interest in children and all those who carry responsibility for
responding to the many challenges posed by HIV/AIDS, including policy-makers,
programme planners and those working directly with children.
72. UNICEF is now working as part of the new United Nations programme on
AIDS. Through that framework, it is seeking effective ways to ensure that
the HIV-related components of these initiatives are a central part of that
coordinated approach to HIV/AIDS action. Preparations are under way for a
detailed review, together with the Joint Programme, of UNICEF's experience in
over 30 strategic programming countries. This review will seek to synthesize
the work of the inter-agency technical support groups and to harmonize these
continuing efforts with the work of the Joint Programme.
C. United Nations Development Programme
73. Since the last report to the General Assembly and the Economic and Social
Council of the Director-General of WHO, UNDP has continued to work within the
framework of the WHO/UNDP Alliance to Combat AIDS and the memorandum of
Understanding signed by both agencies to facilitate the implementation of the
Alliance.
74. The primary focus of the UNDP HIV and development programme is to learn
the lessons of what works and what does not, namely, to understand
development practice in this area better and to strengthen national capacity
to develop effective and sustainable community-based and multidimensional
programmes. Within this context and in collaboration with many development
partners, UNDP has initiated and supported a broad range of activities. The
HIV and development programme is contributing to the global response to the
epidemic by assisting countries to understand better the interdependent
relationships between development and the HIV epidemic and to strengthen
understanding of its potential psychological, social and economic impact.
The approach adopted includes advocacy, training workshops, discussion
papers, seminars, the development of multisectoral planning tools and
participatory and community-based monitoring, documentation, evaluation and
programme development approaches. The programmatic approaches and processes
being identified and developed take into account the complexity of behaviour
change and of support to those affected, locating the processes of change
within the community itself while strengthening the institutional
infrastructure required for programme and policy development.
75. One example of the importance that UNDP places upon working in
partnerships has been the creation of the partnership programme to enhance
national capacity to analyse and respond to the psychological, social and
economic determinants and consequences of the HIV epidemic. The main focus
of UNDP in this area is to assist selected communities, academic institutions
and countries to create and strengthen their capacity to undertake
HIV-related action-oriented research to analyse the data and findings in a
manner that would be directly relevant to national programme and policy
development and to assist community organizations, programme managers, other
government officials, activists and leaders to assess and redesign their
policies and interventions in the light of the research findings. The
programme is currently concentrating on facilitating the work of research
teams in the Central African Republic, Kenya, Senegal and Zambia through
partnerships with resource persons and academic institutions from different
regions of Africa, North America and Europe.
76. An important part of UNDP's approach to ensuring an effective and
sustainable response to the epidemic has been the establishment of a
protective and supportive legal, ethical and human rights environment. The
approach has been based on two critical components: global advocacy of these
issues and the development of a local capacity to develop appropriate
responses through the establishment of national and regional networks on
human rights, law and ethics. Programme activities to date in this area have
concentrated on facilitating the establishment of national and regional
networks on ethics, law and HIV in Africa, Asia and the Pacific, and Latin
America and the Caribbean, through exploratory missions, technical
assistance, seed funds for establishing national networks, planning meetings
and intercountry consultations. An intercountry consultation that led to the
formation of the regional network of Asia and the Pacific on law, ethics and
HIV was held in May 1993 in the Philippines. This consultation brought
together members of 15 national networks from the Asia/ Pacific region. The
intercountry consultation of the African network on ethics, law and HIV,
which launched this regional network on 1 July 1994 in Senegal, united eight
national networks and has provided the impetus for additional African
countries to form networks.
77. UNDP's work within the HIV epidemic has also stressed the crucial
importance of partnerships with organizations of people living with HIV and
AIDS and with organizations that support them in all regions within UNDP's
mandate. One manifestation of such partnerships was the First Conference of
the Network for African People Living with HIV/AIDS, held in Kenya in
May 1994, which brought together people from 13 French- and English-speaking
African countries and the subsequent launching of this network.
78. UNDP has also been instrumental in the establishment of a civil-military
alliance to combat the HIV epidemic, thus also linking issues of national
security to the processes of development.
79. UNDP's focus on supporting and implementing programmes to assist and
empower women to respond to and survive within the HIV epidemic is integrated
into all of its programme and policy initiatives. The approach has been to
identify and address the particular factors - cultural, social, legal,
psychological and economic - which make women vulnerable, whilst at the same
time recognizing that the issues relevant to men's behaviour and
vulnerabilities must also be addressed. UNDP has brought to the issues
surrounding women and HIV the experiences and lessons of three decades of
work on women and development. The identification of issues relating to the
particular vulnerability of young women and post-menopausal women to HIV
infection was the subject of a UNDP study on young women and HIV. This
study, along with other publications, has had a critical impact on revisions
to research and programme priorities in this area.
80. A number of additional key areas related to the socio-economic causes and
consequences of the HIV epidemic are examined in UNDP's Issues Paper series,
including the economic impact of the epidemic, people living with HIV (law,
ethics and discrimination), placing women at the centre of the analysis,
behaviour change (analogies and lessons from the experience of homosexual
communities), the role of the law in HIV and AIDS policy, children in
families affected by the HIV epidemic, and many others. UNDP publications
also include documents on AIDS in Asia, HIV and development in Africa and,
most recently, a book entitled "HIV and AIDS: the Global Interconnection",
which brings together chapters written from different perspectives by
activists, government officials, educators, health-care workers, artists,
journalists and others from around the world. Their stories of living with
and responding to HIV demonstrate that HIV and AIDS are not only a challenge
facing individuals, but a challenge facing families, communities, nations and
the entire world. These publications are consistently distributed to all of
UNDP's 132 country offices, as well as other partners and interested
nongovernmental and community-based organizations, particularly those seeking
insight on how to respond to the HIV epidemic in developing countries.
D. United Nations Population Fund
81. UNFPA provides support for HIV/AIDS prevention and control activities in
line with national AIDS control policies and programmes, and within the scope
of the overall global AIDS strategy. UNFPA AIDS prevention activities are
integrated into ongoing programmes and projects in the population sector,
particularly, MCH/family planning (MCH/FP) service delivery and information,
education and communication programmes and projects.
82. UNFPA support for HIV/AIDS prevention activities during 1993 and 1994
focused on the following areas: (a) education and communication, including
the in-school and out-of-school population and family-life education, and
public information and education activities on HIV/AIDS; (b) MCH/FP services,
including support for preventive counselling on HIV/AIDS and the widespread
distribution of condoms and spermicides as part of MCH/FP service programmes,
and equipment and supplies for the protection of MCH/FP personnel, including
traditional birth attendants; (c) training, including the incorporation of
HIV/AIDS education and information components into all pertinent training
programmes, particularly those for service providers and counsellors; and
(d) research, including sociodemographic, operational, and biomedical
research.
83. UNFPA supported HIV/AIDS prevention activities in over 90 countries
during 1993 and 1994. Increasing attention was given to activities
addressing the reproductive health needs of women, youth and adolescents. In
many of these HIV/AIDS prevention activities, UNFPA collaborated closely with
various United Nations agencies and organizations such as the ILO, UNDP,
UNICEF, UNESCO and WHO, and with several NGOs. The latter have included the
Algerian Association of Family Planning, the Belize Family Life Association,
the Burundi Association for Family Welfare, the Cook Islands Child Welfare
Association, the Family Life Association of Swaziland, the Family Planning
Association of Turkey, the Federation Togolaise des Associations et Clubs
UNESCO, the Fijian Council of Women, the Guyana Responsible Parenthood
Association, the Groundwork Theatre in Jamaica, the Social Marketing Network
in Haiti, the Syrian Family Planning Association, the Tata Institute for
Social Sciences in India, and the World Scouts Bureau in Kenya. During 1994,
the Fund prepared and distributed the 1993 AIDS Update, an annual publication
highlighting UNFPA's support for HIV/AIDS prevention activities around the
globe.
84. In 1993 and 1994 UNFPA supported several regional and interregional
activities in the area of HIV/AIDS prevention. In the Africa region,
HIV/AIDS prevention modules were incorporated in the training programme in
clinical skills offered in Mauritius; in the population and communication
regional training programme in Kenya; and in the Portuguese-language training
programmes in clinical skills in Mozambique and Sao Tome. In the Asia and
the Pacific region, UNFPA provided support to the UNESCO-executed regional
project on population education and communication. During 1993-1994, project
activities included the dissemination of AIDS prevention information
materials for adolescents; translation of teaching materials on AIDS
education from Thai into English; and collaboration with other United Nations
agencies in the workshop held in the Philippines on the economic implications
of HIV/AIDS.
85. In the Latin America and the Caribbean region, HIV/AIDS prevention
information was included in the educational materials developed by the UNFPA-
supported project on population education for out-of-school rural youth in
Central America. The institutional capacity of rural youth organizations has
been strengthened so as to enable them to disseminate directly population
education and AIDS-awareness messages to their target audience of youth in
rural areas, and to policy makers. In addition, under the UNFPA-supported
and PAHO-executed project on quality of care in family planning services,
regional workshops have been organized to test a model on women's
reproductive health services. The model includes a component on HIV/AIDS
prevention.
86. At the interregional level, UNFPA participated actively in meetings to
develop the joint and co-sponsored United Nations programme on AIDS. This
included the assignment of a senior technical officer to the Geneva-based
transition team to assist in the preparation of a comprehensive proposal to
be submitted to the Economic and Social Council.
87. Additionally, to promote and enhance coordination of HIV/AIDS prevention
activities, UNFPA participated in meetings of the Inter-Agency Advisory Group
on AIDS and the WHO Global Programme on AIDS Management Committee. Financial
support was provided by UNFPA to the Management Committee Task Force on
HIV/AIDS coordination for the publication of the biennial report on HIV/AIDS
activities. Under the auspices of the Joint Consultative Group on Policy,
UNFPA supported and actively participated in the inter-agency training of
trainers on HIV workshops organized in Zimbabwe in 1993 and in Senegal and
Colombia in 1994.
88. UNFPA worked closely with WHO in preparing estimates for condom
requirements for HIV/AIDS prevention as part of in-depth studies in Turkey,
Viet Nam, the Philippines (during 1993), Bangladesh, Brazil and Egypt (during
1994) undertaken within the framework of the Fund's Global Initiative on
Contraceptive Requirements and Logistics Management Needs in Developing
Countries in the 1990s. UNFPA also published and disseminated a technical
report entitled "Contraceptive Use and Commodity Costs in Developing
Countries, 1994-2005", prepared in collaboration with the Population Council.
The report includes global estimates of condom requirements for STD/AIDS
prevention, prepared by WHO.
89. UNFPA also provided support to the WHO project on family planning
technologies. Under this project an integrated version of the guidelines on
HIV/AIDS prevention in MCH/FP programmes is being developed. Support has
also been provided to a WHO project focusing on reproductive health and
adolescence, which incorporates HIV/AIDS prevention activities.
90. In 1993, the World Assembly of Youth, with support from UNFPA,
disseminated information to youth and youth organizations on issues including
population and development, adolescent health, sex education, drug abuse
prevention, and HIV/AIDS prevention. UNFPA provided support to the
Population Council's International Committee for Contraception Research,
which includes the development of microbicides/spermicides that protect
against STDs, including HIV/AIDS.
91. During 1993, UNFPA prepared the main background document for the round
table on the impact of HIV/AIDS on population policies and programmes that
was organized as part of the preparatory process for the International
Conference on Population and Development.
92. The International Conference on Population and Development, held in Cairo
from 5 to 13 September 1994 clearly identified HIV/AIDS prevention as an
important component of reproductive health and thus reaffirmed the approach
already begun by UNFPA in this area. As part of the follow-up to the
International Conference on Population and Development, UNFPA organized in
December 1994, an expert consultation on reproductive health and family
planning: directions for UNFPA assistance. Inputs from this meeting
together with the recommendations of the International Conference will serve
to develop further and enhance UNFPA support for HIV/AIDS prevention
activities.
E. Office of the United Nations High Commissioner for Refugees
93. During 1993-1994, in collaboration with WHO, NGOs and local authorities,
UNHCR carried out numerous assessments of activities being undertaken to
ensure that STD/HIV/AIDS prevention and care are being addressed
systematically in refugee camps. This has resulted in the
institutionalization of HIV/AIDS activities as an integral part of the
health-care delivery systems in refugee camps. It also highlighted the need
to develop practical guidelines for (a) the prevention of the transmission of
HIV/AIDS including management of curable STDs, condom promotion and
distribution as well as blood safety and (b) the care and support of refugees
with HIV/AIDS (e.g. the WHO recommendations for the prevention of HIV/AIDS in
Rwanda).
94. UNHCR addressed the situation of violence against women and the type and
quality of reproductive health services, including existing infrastructures,
gaps, resources and projects designed to prevent, treat and protect refugee
women against rape, sexual abuse and forced prostitution. This resulted in
the development of guidelines for field staff on violence and rape among
refugees which were issued in March 1995, entitled "Sexual Violence Against
Refugees: Guidelines on Prevention and Response".
95. In collaboration with other United Nations system agencies and bilateral
organizations, the Office undertook studies on knowledge, attitude and
behaviour in several countries so as to streamline HIV/AIDS activities within
the framework of national AIDS programmes.
96. Given that condoms offer effective protection against the sexual
transmission of HIV if consistently and correctly used, UNHCR took a policy
decision to begin the systematic inclusion of condoms in relief supplies at
the outset of every emergency. This has encouraged implementing partners to
treat HIV/AIDS as a priority issue in refugee health care. UNHCR promotes
coordination between national AIDS programmes, United Nations system agencies
and the NGOs involved in refugee health care in order to ensure effective and
technically sound programme formulation and implementation, consistent with
the global AIDS strategy.
F. United Nations International Drug Control Programme
97. The United Nations International Drug Control Programme (UNDCP)
implements the global AIDS strategy primarily by helping to design and fund
projects in developing countries. The main regions of the world where HIV
infection is spread via drug abuse are in Latin America and Asia. In Latin
America, and Brazil in particular, where there is evidence that cocaine is
injected, there is an acute problem. UNDCP has contributed US$ 2,300,000
towards a US$ 9 million World Bank project that aims to reduce or stabilize
the transmission of HIV among injecting drug users in 10 priority States by
providing outreach services (including needle exchange) and treatment. The
project also aims to prevent drug abuse and HIV transmission among the
general population, with an emphasis on those with high-risk behaviours, such
as prostitutes and street children. The project started in 1994 and will run
for three years.
98. UNDCP undertook studies in Myanmar and Viet Nam on injecting drug use and
HIV infection. Based on the findings a subregional project for prevention of
HIV and other harmful consequences of injecting drug use is in the process of
formulation. The countries included are Cambodia, China, the Lao People's
Democratic Republic, Myanmar, Thailand and Viet Nam.
G. International Labour Organization
99. During 1993-1994 the AIDS-related activities of ILO focused on four
interlinked areas: protecting the employment rights of HIV-positive persons
or persons with AIDS; promoting public information and education about AIDS
in the workplace, through companies and through employers' and workers'
organizations; protecting the health of workers who are occupationally
exposed; and analysing the consequences of AIDS on human resources and labour
supply and on social security schemes.
100. Education activities within national projects on population and
family welfare education deal with issues of reproduction, responsible sexual
behaviour, family health, contraception and AIDS education. AIDS was also a
component of ILO projects on cooperatives and public works programmes.
101. On the basis of earlier work on sexual protection in the workplace,
global feminization of precarious labour and inequalities observed in labour
markets and syntheses of data on teenage pregnancy in sub-Saharan Africa, ILO
issued papers on general and labour issues in the spread of HIV/AIDS,
socio-economic aspects of sex roles and reproductive health and female
workers' sexual vulnerability: the need for workplace protection.
102. During the biennium, ILO continued to promote the adoption and
application of national legislation, collective agreements and enterprise
policies to deal with AIDS and the workplace, consistent with the principles
set down in the joint WHO/ILO statement on AIDS and the workplace and the
relevant international labour conventions, especially the Discrimination
(Employment and Occupation) Convention, 1958 (No. 111). This Convention
includes the adoption of specific laws and regulations relating to
recruitment, screening, confidentiality, training and information, social
protection, etc. The ILO Committee of Experts on the Application of
Conventions and Recommendations, which supervises the application by Member
States of ratified Conventions, periodically examines information provided in
Governments' reports concerning the application of Convention No. 111 on the
measures taken, in legislation and in practice, to protect HIV-positive
persons and persons with AIDS, against discrimination in employment. It has
been proposed that the Convention could be revised to include specific
mention of discrimination on the basis of health status.
103. As part of an international study on legislation and enterprise
practice being carried out in 13 countries, national case studies have been
completed or are being finalized by national consultants in Africa (Cote
d'Ivoire, South Africa, Uganda); the Americas and the Caribbean (Brazil,
Jamaica, Mexico, United States of America); Asia (India, Indonesia,
Thailand); Europe (France, Poland, Switzerland). Results will be published
by the end of the year, and may be submitted for discussion at a joint
WHO/ILO meeting proposed for next year which would review the 1988 joint
WHO/ILO statement on AIDS and the workplace and draw up a code of good
practice.
104. ILO organized tripartite workshops on the methods of control of
HIV/AIDS and protection of workers against discrimination, including
development and implementation of enterprise policies related to testing,
confidentiality, counselling, leave, medical care, insurance, occupational
health and sexual harassment. These themes were fully treated in the
tripartite workshop on the role of organized sector in reproductive health
and HIV/AIDS prevention organized in Uganda in November-December 1994 for 20
English-speaking African countries by ILO, with UNFPA's financial support and
joint WHO/ILO technical assistance. The workshop was very well attended by
16 Governments, representatives of 17 employers' and 16 workers'
organizations, and participants from the International Confederation of Free
Trade Unions, the Organization of African Trade Union Unity and AIDSCAP. The
possibility of holding a similar workshop for French-speaking African
countries is being explored.
105. ILO carried out an intercountry study involving Rwanda, the United
Republic of Tanzania, Uganda and Zambia on the impact of HIV/AIDS on the
productive labour force. Among the issues to be addressed in the study are
the incidence of HIV/AIDS among the productive labour force and the effects
of the incidence on labour supply/employment; employment security and
discrimination; labour productivity; labour mobility; wages and labour costs;
education and training; and possible gender dimensions of the processes
involved. The final report, expected to be published shortly, will be used
in national workshops, which will in turn develop recommendations for policy
formulation and action.
H. Food and Agriculture Organization of the United Nations
106. Field work was carried out in 1993 in connection with the study on
the effects of HIV/AIDS on farming systems and rural livelihoods in Uganda,
the United Republic of Tanzania and Zambia and the results presented at a
seminar held in January 1994 with UNDP and the International Fund for
Agricultural Development (IFAD). The study clearly demonstrated the impact
of the epidemic on small farmers, in particular through loss of labour and
resources resulting in a reduction of crop variety and production, a decline
in yields, acreage and livestock production, an increase in pests and
diseases of plants and cattle and, finally, the loss of extension services
and the human capital of knowledge and management skills. These changes also
affect the food security of the rural household. The methodology used in the
study was reviewed in June 1994 at a meeting of the three country research
teams. The methodology was based on rapid participatory rural assessments
and the quality of the results was closely linked to the experience and
composition of the research teams. National workshops were held to convey
the results to national policy and decision makers in the three studied
countries. On the basis of the East African experience, an extension and
adaptation of the study are being considered for 1995 in West Africa.
107. The study served as an input to a section on AIDS in the State of
food and agriculture presented to the FAO Council in November 1994. This was
the first time that a section on AIDS was presented to the Council and
debated by delegations. As a result, the FAO Council, in paragraph 16 of its
report, regretted the global incidence and spread of HIV/AIDS, which was not
just a health issue, but also had adverse implications for agriculture and
food security. The Council urged FAO to continue monitoring the impact of
HIV/AIDS and to cooperate as appropriate with WHO and other agencies in
assessing the adverse effects on food security and to develop a preventive
programme for the benefit of women in agriculture.
108. Three other FAO projects included significant activities in the area
of HIV/AIDS: (a) Strengthening programmes for rural youth and young farmers
in Uganda: as part of the field work a study on the socio-economic impact of
HIV/AIDS on rural families, with special emphasis on youth, was carried out.
During the second project phase an action programme for rural youth in Uganda
was developed as a concerted effort of various government ministries and
NGOs, which recommends addressing HIV/AIDS issues in an integrated manner in
mainstream programmes for agriculture, rural development and youth;
(b) Integration of population education into programmes for rural youth, (a
UNFPA-funded interregional project for 1992-1996): the project builds upon
an earlier project (INT/88/P98) which developed training modules for leaders
of rural youth groups and aims at promoting the use of these materials in
rural youth programmes; adolescent health and HIV/AIDS are a priority in the
training activities. So far activities took place in China, Ethiopia, Viet
Nam and Zimbabwe, and future pilots are planned in eastern Africa (the United
Republic of Tanzania and Uganda), South America (Colombia and Peru) and Asia
(Indonesia, Philippines and Thailand); (c) Population education methodologies
for out-of-school rural youth in Central America became operational in May
1994. So far pilot train-the-trainers activities for rural youth in
population education, including HIV/AIDS issues, have been carried out in
Costa Rica and Nicaragua under the framework of FAO agroforestry and soil
conservation projects. Institutional arrangements for pilot training in El
Salvador, Guatemala and Honduras are currently being finalized. In 1995, a
workshop for material development will be held, which will also produce
updated educational materials on HIV/AIDS.
109. On World AIDS Day 1994, an internal FAO working group on AIDS
organized a symposium opened by the Deputy Director-General, which focused on
both the implications of the epidemic on the staff and on the programme of
work of the organization. Colleagues from WFP and IFAD were invited. It was
decided to follow up the symposium with training seminars in 1995.
I. United Nations Educational, Scientific and Cultural Organization
110. During 1993 and 1994, UNESCO continued to provide technical
assistance to member States and NGOs to develop and implement education
strategies for AIDS prevention, adapted to their different sociocultural
contexts. The final report synthesizing the evaluation results of seven
WHO/UNESCO pilot projects on school AIDS education (1988-1993) was issued.
It describes and provides examples of the integration of STDs and AIDS
education into normal school curricula in Ethiopia, Jamaica, Mauritius, the
Pacific islands, Sierra Leone, the United Republic of Tanzania and Venezuela.
In collaboration with WHO, a resource package on the design of school AIDS
education for use by curriculum planners, teachers and students (12-16 years)
was published in 1994. In this connection, guidelines will also be finalized
during 1995 for use by decision makers in ministries of education. An
international seminar on the impact of HIV/AIDS on education was organized in
France from 8 to 10 December 1993. Regional seminars on planning for AIDS
education in schools have been held or planned: for Asia in India, 10-14
January 1994, for English-speaking Africa in Zimbabwe, January 1995; and for
French-speaking Africa in Senegal, 1996. Work has begun on the development
of a prototype teachers' guide for secondary education and on a study on HIV
transmission linked to injecting drug use.
111. The network "Man against virus", comprising 25 research institutions
and virology laboratories in Europe, North America and Israel and managed by
UNESCO's European Regional Office for Science and Technology in Venice, Italy
(ROSTE) continued its work to coordinate basic research in virology with
HIV/AIDS research as a priority. Its major activities included awarding
research contracts to laboratories and scientists and promoting the exchange
of information among members of the network. In 1993, it co-sponsored the
organization of the Congress "Cancer, AIDS and Society" which took place at
UNESCO headquarters in March. During 1994, the network was responsible for
several important discoveries in relation to the following: (a) the role of
apoptosis; (b) the cofactor role of certain mycoplasms; (c) the multiplier
effect of the production of antibodies by a mucosal immunization effected
before a parenteral injection of "immunosome"; and (d) strengthening the
immunogenetic effect of the protein envelope of the virus by aggregation to a
liposome, called "immunosome". Three members of the network were honoured in
connection with these discoveries. ROSTE Technical Report No. 17 published
in 1994, entitled "Scientific Reports from members of the European Network:
Man against virus", contains an account of progress achieved in scientific
and medical research in the area of HIV/AIDS, as well as new data on
pathogenesis, the prevention and treatment of AIDS, mucosal immunity and the
"immunosome" HIV vaccine. The network is continuing research on measuring
the protective effect of the candidate vaccine and its possible application
in man and the early treatment of HIV-positive subjects.
112. In January 1993, UNESCO established the World Foundation for AIDS
Research and Prevention, an NGO that aims to create a worldwide network of
observation and applied research to identify the most promising research
avenues, particularly with an opening to other disciplines. Three applied
research centres have been established in Cote d'Ivoire for Africa, in France
and in the United States of America. The Foundation, in collaboration with
UNESCO, has established a mobile chair for Ethiopia and Uganda with the aim
of ensuring the training of specialists in AIDS prevention and education for
groups of youth and children.
J. International Civil Aviation Organization
113. One of the main concerns of the International Civil Aviation
Organization (ICAO) is to ensure the safety of flight operations. From the
onset of HIV/AIDS and until recent years, there was little evidence that
linked the risk of aviation incidents and accidents to the HIV status of the
pilots. Consequently there are no provisions with regard to HIV/AIDS in any
ICAO document. For licensing purposes, HIV and AIDS are covered together
with other disorders and diseases within the medical provisions of chapter 6
of annex 1 to the Convention on International Civil Aviation. Thus an
applicant is required to be free from any condition or disability that would
entail functional incapacity likely to interfere with the safe operation of
an aircraft. At an ICAO aeromedical seminar held in France in November 1989
at which problems of HIV and AIDS were discussed, the position taken by the
medical officers present was that HIV testing of applicants for aviation
licences was neither necessary nor advantageous.
114. In recent years, there has been concern that subtle, but
aeromedically significant neuropsychiatric changes may occur in an
HIV-positive person who is otherwise asymptomatic. While detection of a
neuropsychiatric deficit in an HIV-infected person at annual or semi-annual
intervals could be sufficient to allow timely medical intervention, this may
not be an adequate safeguard for aviation. Thus the medical debate
concerning whether pilots infected with HIV should be permitted to pilot an
aircraft continues. Many aeromedical specialists around the world now
consider that international guidelines are required. ICAO is considering
taking steps to revise and amend its medical provisions and guidance
material.
K. World Bank
115. The World Bank first began to finance AIDS prevention and control
activities in 1986, as components of broader health and social sector
projects. In 1989 it approved its first project devoted predominantly to
support of AIDS activities. By the end of fiscal year 1994 there were 5 such
freestanding projects, and AIDS activities were included in over 40 human
resource development and social sector projects in 30 countries. It is
expected that at least one freestanding AIDS/STDs project will be approved by
the Bank's Board in 1995, and that several others will have AIDS components.
116. The five freestanding projects support the programmes of the
Governments of Brazil, Burkina Faso, Honduras, India and Zaire, and Bank
commitments to these projects total US$ 328.4 million. Funding for AIDS
components within broader health projects ranges from US$ 50,000 to
US$ 21.5 million. In all, World Bank loans and credits for HIV/AIDS-related
activities are valued at over US$ 500 million, and projects programmed for
lending within the near future will bring another US$ 150 million to the
field.
117. The projects support action in nine priority areas: promoting safer
sexual behaviour, preventing unsafe drug-use behaviour, promoting safe blood
supplies, providing condoms, providing care and support, providing voluntary
counselling and testing, providing STD care, programme management
improvements and research. In many of these areas NGOs are playing an
important role. Although World Bank loans are made directly to Governments,
recognition of the NGO contribution to AIDS prevention and control has led to
considerable effort on the part of Governments to involve them in the design
and implementation of projects, with the full support of the Bank.
118. The Bank's lending for AIDS activities is supported by two forms of
analysis: sector work and research. Country-specific sector work precedes
project lending and provides the basis for discussion with Governments and
for project design. The Bank's research work has focused mainly on the
economic and social impact of HIV/AIDS. In addition, the Bank complements
its own activities - in lending, sector work and research - by support for
WHO's Global Programme on AIDS, to which it contributes US$ 1 million a year.
Notes
1/ Document WHO/GPA/IDS/HCS/91.6.
2/ Document WHO/GPA/IDS/HCS/93.3.
3/ Document WHO/GPA/IDS/HCS/93.2.
4/ Document WHO/GPA/IDS/HCS/92.1.
5/ Document WHO/GPA/DIR/93.3.
6/ A/47/558, annex II, AHG/Decl.1 (XXVIII).
7/ A/49/313, annex II, AHG/Decl.1 (XXX).
8/ Report of the World Conference on Human Rights, Vienna,
14-25 June 1993 (A/CONF.157/24 (Part I)), chap. III.
9/ E/CN.4/1995/45.
10/ E/CN.4/Sub.2/1993/9.
-----

This document has been posted online by the United Nations
Department of Economic and Social Affairs (DESA). Reproduction and dissemination of the
document - in electronic and/or printed format - is encouraged, provided acknowledgement
is made of the role of the United Nations in making it available.

Date last posted: 18 December 1999 16:30:10Comments and suggestions: esa@un.org